Mortality risk stratification in contemporary myocardial infarction-related cardiogenic shock: development of AMICS-ADMIT prediction model and benchmarking of established scores.
- 1Philipps-Universität Marburg, Department of Cardiology, Angiology, and Intensive Care Medicine, Baldingerstraße, Marburg, 35043, Germany.
Abstract
Background
Mortality risk stratification in acute myocardial infarction complicated by cardiogenic shock (AMI-CS) remains challenging with heterogeneous temporary mechanical circulatory support (tMCS) use. We developed and temporally validated the admission-based AMICS-ADMIT model and bedside score and benchmarked them against established scores.Methods
This retrospective single-centre study, reported according to TRIPOD+AI, included 479 consecutive patients with AMI-CS undergoing percutaneous coronary intervention (PCI) between January 2017 and July 2025. The primary endpoint was in-hospital mortality. AMICS-ADMIT was developed using multivariable logistic regression in the 2017-2022 cohort, internally evaluated by bootstrap resampling, and temporally validated in the 2023-2025 cohort. Missing data were multiply imputed. Performance was assessed using discrimination, calibration, and Brier scores. Benchmarking against CardShock, IABP-SHOCK II, and GRACE was restricted to temporal validation; tMCS-stratified performance was exploratory.Results
In-hospital mortality was 42.6% (204/479). The final model included age, left ventricular ejection fraction, prior cardiopulmonary resuscitation, estimated glomerular filtration rate, vasoactive-inotropic score, and ST-segment elevation status. The continuous model achieved AUCs of 0.809 (95% CI 0.764-0.855) in development and 0.834 (95% CI 0.769-0.899) in temporal validation, with Brier scores of 0.176 and 0.167 and favourable calibration. The bedside score achieved AUCs of 0.777 (95% CI 0.728-0.826) and 0.775 (95% CI 0.699-0.851), respectively, with stepwise mortality separation across predefined risk categories. Discrimination did not differ significantly from CardShock, IABP-SHOCK II, or GRACE.Conclusions
AMICS-ADMIT showed stable temporal performance and clinically interpretable early risk stratification in contemporary PCI-treated AMI-CS. External multicentre validation is required before clinical implementation.
Related
- Cytomegalovirus Retinitis Across the Immunosuppression Spectrum: A Contemporary Framework for Risk Stratification, Diagnosis, and Vision-Preserving Therapy
- Clinically Accessible Phenotypes Refine Cardiovascular Risk Stratification Beyond Contemporary Clinical Equations
- Enhanced Early Risk Stratification in Cardiogenic Shock Using Machine Learning: A Hierarchical Clustering Analysis.
- Temporary Mechanical Circulatory Support in Acute Myocardial Infarction-Related Cardiogenic Shock: Lessons from Contemporary Randomized Trials
- Norepinephrine Equivalent Dose for Mortality Risk Stratification in VA-ECMO Cardiogenic Shock
BibTeX
@article{mihali2026mortality,
title = {{Mortality risk stratification in contemporary myocardial infarction-related cardiogenic shock: development of AMICS-ADMIT prediction model and benchmarking of established scores.}},
author = {Klevis Mihali and Birgit Markus and Kornelia Neuner and Georgios Chatzis and Lukas Harbaum and Mykyta Fomin and Maryana Choukeir and Styliani Syntila and Bernhard Schieffer and Julian Kreutz},
journal = {International journal of cardiology. Heart \& vasculature},
year = {2026},
month = oct,
doi = {10.1016/j.ijcha.2026.102029},
url = {https://europepmc.org/article/MED/42908764},
note = {CC BY},
}
RIS
TY - JOUR
TI - Mortality risk stratification in contemporary myocardial infarction-related cardiogenic shock: development of AMICS-ADMIT prediction model and benchmarking of established scores.
AU - Klevis Mihali
AU - Birgit Markus
AU - Kornelia Neuner
AU - Georgios Chatzis
AU - Lukas Harbaum
AU - Mykyta Fomin
AU - Maryana Choukeir
AU - Styliani Syntila
AU - Bernhard Schieffer
AU - Julian Kreutz
PY - 2026
DA - 2026/10/14
JO - International journal of cardiology. Heart & vasculature
DO - 10.1016/j.ijcha.2026.102029
UR - https://europepmc.org/article/MED/42908764
AB - Background Mortality risk stratification in acute myocardial infarction complicated by cardiogenic shock (AMI-CS) remains challenging with heterogeneous temporary mechanical circulatory support (tMCS) use. We developed and temporally validated the admission-based AMICS-ADMIT model and bedside score and benchmarked them against established scores.Methods This retrospective single-centre study, reported according to TRIPOD+AI, included 479 consecutive patients with AMI-CS undergoing percutaneous coronary intervention (PCI) between January 2017 and July 2025. The primary endpoint was in-hospital mortality. AMICS-ADMIT was developed using multivariable logistic regression in the 2017-2022 cohort, internally evaluated by bootstrap resampling, and temporally validated in the 2023-2025 cohort. Missing data were multiply imputed. Performance was assessed using discrimination, calibration, and Brier scores. Benchmarking against CardShock, IABP-SHOCK II, and GRACE was restricted to temporal validation; tMCS-stratified performance was exploratory.Results In-hospital mortality was 42.6% (204/479). The final model included age, left ventricular ejection fraction, prior cardiopulmonary resuscitation, estimated glomerular filtration rate, vasoactive-inotropic score, and ST-segment elevation status. The continuous model achieved AUCs of 0.809 (95% CI 0.764-0.855) in development and 0.834 (95% CI 0.769-0.899) in temporal validation, with Brier scores of 0.176 and 0.167 and favourable calibration. The bedside score achieved AUCs of 0.777 (95% CI 0.728-0.826) and 0.775 (95% CI 0.699-0.851), respectively, with stepwise mortality separation across predefined risk categories. Discrimination did not differ significantly from CardShock, IABP-SHOCK II, or GRACE.Conclusions AMICS-ADMIT showed stable temporal performance and clinically interpretable early risk stratification in contemporary PCI-treated AMI-CS. External multicentre validation is required before clinical implementation.
SN - 2352-9067
ER -